1
|
Serchen J, Hilden DR, Beachy MW. Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:1099-1103. [PMID: 38914001 DOI: 10.7326/m24-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
Collapse
Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
| |
Collapse
|
2
|
Guy A, McAuliffe S, Cross R, Zhang Y, Kennedy RE, Estes NR, Giordano-Mooga S, Loyd C. Pilot study assessing gut microbial diversity among sexual and gender minority young adults. PLoS One 2024; 19:e0306638. [PMID: 38959280 PMCID: PMC11221641 DOI: 10.1371/journal.pone.0306638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
Evidence supports that people identifying as a sexual or gender minority (SGMs) experience minority-related stress resulting from discrimination or expectations of prejudice, and that this is associated with increased mental and physical health problems compared to cisgender heterosexuals. However, the biological mechanisms driving minority-related stress impacts remain unknown, including the role of the gut microbiome. Thus, the aim of this study was to determine the relationship between SGM status and gut microbiome health among young adults attending a 4-year university. To this end, a prospective pilot study was completed in the fall and spring semesters of 2021-22. Self-identified SGMs (N = 22) and cisgender-heterosexuals (CIS-HET, N = 43) completed in-person interviews to provide mental health data and demographic information. Nail and saliva samples were collected at the time of interview to quantify chronic and acute cortisol. Stool samples were collected within 48 hours of interview for microbiome analysis. Assessment of the gut microbiota identified a significant reduction in alpha diversity among the SGM group, even when adjusting for mental health outcome. SGM group showed trends for higher abundance of microbes in phylum Bacteroidetes and lower abundance of microbes in phyla Firmicutes, Actinobacteria, and Proteobacteria compared to the CIS-HET group. These findings support that the gut microbiome could be contributing to negative health effects among the SGM community.
Collapse
Affiliation(s)
- Ashley Guy
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Shannon McAuliffe
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Robbie Cross
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Richard E. Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Norman R. Estes
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Samantha Giordano-Mooga
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| |
Collapse
|
3
|
Zaliznyak M, Gonzales M, Gaither TW. Obesity and sexual health trends among a large, national sample of men who have sex with men on Grindr in the USA. Sex Health 2024; 21:SH24049. [PMID: 39013024 DOI: 10.1071/sh24049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
Background A growing number of men who have sex with men (MSM) utilise Grindr for seeking relationships and immediate/casual sexual encounters. Grindr and other mobile applications can be a valuable source of information on sociological predictors of health. One topic that is under reported is the use of Grindr by MSM with obesity. We described differences in Grindr use between MSM with and without obesity, and to use Grindr information to reveal trends which may serve as potential predictors of health. Methods Data was collected from 3744 Grindr users (mean age [s.d.], 32.3 years [9.1]) from the largest 50 metropolitan centres in the USA between February and May 2018. Users were divided into two cohorts based on BMI: (1) MSM with obesity (BMI>30), n =253; and (2) MSM without obesity, n =3491. Profile characteristics were compared. Results When evaluating potential predictors for obesity, we found that black/African-American and older MSM were significantly more likely to have obesity. Further, we found that obesity among MSM was significantly inversely associated with the population percent lesbian, gay, bisexual, and transgender (LGBT) within a city. Additionally, we found that MSM with obesity were significantly more likely to indicate interest in immediate sexual encounters. Conclusions These results highlight important trends that may serve as predictors of health in urban settings. Furthermore, our results suggest that MSM with obesity may be more likely to engage in risky sexual behaviours. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population.
Collapse
Affiliation(s)
- Michael Zaliznyak
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Manuel Gonzales
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
4
|
Davis MG, Sanders BD. Updates in Medical and Surgical Weight Loss. J Midwifery Womens Health 2024; 69:414-421. [PMID: 38831484 DOI: 10.1111/jmwh.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/24/2024] [Indexed: 06/05/2024]
Abstract
The number of individuals with obesity is at an all-time high, and the rate of obesity continues to climb each year. Obesity is a chronic disease with widespread effects throughout the body. Midwives and perinatal care providers need an understanding of the etiology, pathophysiology, and interventions for obesity. A review of evidence-based diet and lifestyle modifications, medications, and surgical procedures is presented.
Collapse
Affiliation(s)
- Melissa G Davis
- Vanderbilt University School of Nursing and Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bethany D Sanders
- Vanderbilt University School of Nursing and Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
5
|
Krenek B, Tundealao S, Beauchamp JES, Savitz SI, Tamí-Maury I. Comparing Stroke Risk Factors Among Sexual Minority Groups in Texas. Int J Behav Med 2024:10.1007/s12529-024-10267-5. [PMID: 38396275 DOI: 10.1007/s12529-024-10267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Knowledge gaps remain on stroke risk and disparities between sexual minority (SM) subgroups. In this study, stroke risk between SM subgroups, specifically gay/bisexual men and lesbian/bisexual women (G/BM and L/BW), was assessed. METHOD Data were collected in June 2022 using a bilingual (English and Spanish) cross-sectional paper-and-pen survey distributed among 183 SM individuals attending the 2022 Houston Pride Parade and Festival, as well as across Texas via phone call or online format. Relevant sociodemographic and stroke risk factors were compared between G/BM and L/BW using chi-square (or Fisher's exact, when appropriate) and two-sample t-tests. Sexual orientation was used to predict stroke risk using multiple binomial logistic regression, adjusting for other sociodemographic determinants. RESULTS While comparing the stroke risk factors between G/BW and L/BW, statistically significant differences were found in hypertension (p = 0.047), age (p < 0.001), smoking status (p = 0.043), cholesterol level (p < 0.001), and HIV (p = 0.038). G/BM were 2.79 times more likely to have a higher stroke risk compared to L/BW (aOR = 2.79; CI, 1.11-6.05, p = 0.032), after adjusting for other sociodemographic factors. CONCLUSION This pilot study, conducted in Texas, adds to the existing scientific literature on stroke risk among the SM population and revealed that G/BM might have a higher stroke risk compared to L/BW. These findings can inform future research and intervention designs tailored to G/BM and L/BW communities and improve their overall health.
Collapse
Affiliation(s)
- Brittany Krenek
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Samuel Tundealao
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer E S Beauchamp
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sean I Savitz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Irene Tamí-Maury
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston, Houston, TX, USA.
| |
Collapse
|
6
|
Devlin EA, Newcomb ME, Whitton S. Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth. LGBT Health 2024; 11:103-110. [PMID: 37819720 PMCID: PMC10924190 DOI: 10.1089/lgbt.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.
Collapse
Affiliation(s)
- Emily A. Devlin
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - Sarah Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
7
|
Cantor A, Radix A. LGBTQ-competent obesity prevention and management. JAAPA 2023; 36:29-32. [PMID: 38634479 DOI: 10.1097/01.jaa.0001016412.60110.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
ABSTRACT Obesity is a complex and largely preventable disease that is an enormous burden to patient health and to the healthcare system. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients and their healthcare providers should be aware of their personal risks and causes of weight gain and obesity. Sensitive, comprehensive, and competent LGBTQ preventive care and treatment are needed to address the needs of this population, improve patient outcomes, and reduce healthcare inequalities. Research is needed to further evaluate the confluence of obesity and metabolic risk factors in LGBTQ patients, and to develop prevention and treatment strategies to reduce the risk for obesity-related comorbidities, chronic disease, and death.
Collapse
Affiliation(s)
- Aviva Cantor
- At Callen-Lorde Community Health Center in New York City, Aviva Cantor is HIV quality coordinator and Asa Radix is senior director of research and education. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | |
Collapse
|
8
|
Choi YM, Pilkerton CS, Xiang J, Ashcraft AM, Seymour KA, Szoka N. Risk factors for metabolic syndrome in self-identified and questioning sexual minority women. Obesity (Silver Spring) 2023; 31:2853-2861. [PMID: 37723848 DOI: 10.1002/oby.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Studies have shown sexual minority women (SMW) have a higher incidence of obesity, but the risk of metabolic syndrome (MetS) in SMW is unclear. We examined the association between sexual orientation and MetS and its components. METHODS Data were extracted from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2016 examining women aged 20 to 59 years. Participants were divided into three categories: heterosexual, self-identified SMW, and questioning SMW. Logistic regression was used to analyze the association between sexual orientation and MetS. RESULTS Of 12,755 women, 708 (5.6%) were self-identified SMW, and 365 (2.9%) were questioning SMW. The incidence of MetS was not significantly different across the groups. Logistic regression demonstrated that self-identified SMW had significantly higher odds of large waist circumference (odds ratio [OR] 1.39; 95% CI: 1.14-1.71) and obesity (OR 1.53; 95% CI: 1.24-1.90), while questioning SMW had significantly higher odds of low levels of high-density lipoprotein (OR 1.5; 95% CI: 1.13-1.98) compared with heterosexual women. CONCLUSIONS Self-identified and questioning SMW did not have an increased incidence of MetS compared with heterosexual women, but they had higher odds of large waist circumference and low high-density lipoprotein, respectively. Further studies are needed to identify the gaps in social determinants of health in SMW.
Collapse
Affiliation(s)
- Young Mee Choi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Courtney S Pilkerton
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Jun Xiang
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Amie M Ashcraft
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Keri A Seymour
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
9
|
Ferrero EM, Yunker AG, Cuffe S, Gautam S, Mendoza K, Bhupathiraju SN, Mattei J. Nutrition and Health in the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Community: A Narrative Review. Adv Nutr 2023; 14:1297-1306. [PMID: 37536566 PMCID: PMC10721458 DOI: 10.1016/j.advnut.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Sexual and gender minorities have a higher risk for health and nutrition-related disparities across the life course compared to the heterosexual or cisgender population. Experiences of stigmatization and discrimination are associated with diminished mental health quality and psychological distress, which are risk factors for developing various eating disorders. Other nutrition disparities include increased risk for food insecurity, body dissatisfaction, and weight complications, such as those experienced by the transgender population in association with gender-affirming hormone therapies. Despite the need for tailored nutrition recommendations that address the unique needs of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, there are currently no such guidelines in North America. The purpose of this review is to summarize major LGBTQ+ nutrition disparities and highlight the need for tailored recommendations. We examine the evidence on mental health and social disparities in this group, including vulnerabilities to disordered eating, food insecurity, and healthcare provider discrimination. Importantly, we identify a scarcity of literature on dietary concerns and nutrition care guidelines for LGBTQ+ groups, including studies that address intersectionality and differences among specific gender and sexual orientations. These gaps underline the urgency of prioritizing nutrition for LGBTQ+ health needs and for developing tailored public health nutrition recommendations for this underserved population. Our review suggests that future LGBTQ+ health and nutrition research agendas should include personalized and precision nutrition, social determinants of health, diet quality, body image, and healthcare provider cultural competency and responsiveness. Moreover, the current evidence on LGBTQ+ nutrition and health will be strengthened when research studies (including clinical trials) with robust methodologies amplify inclusion and representation of this community to elucidate health and nutrition disparities in sexual and gender minorities.
Collapse
Affiliation(s)
- Elisabetta M Ferrero
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra G Yunker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sherri Cuffe
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Saloni Gautam
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| |
Collapse
|
10
|
Gomez J, Barnes LA, Yost JM, Gordon J, Ginsberg BA, Aleshin M. Hidradenitis suppurativa in sexual and gender minorities: A review and considerations for providers. J Am Acad Dermatol 2023; 89:795-801. [PMID: 35283243 DOI: 10.1016/j.jaad.2022.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023]
Abstract
The literature on hidradenitis suppurativa in sexual and gender minorities remains sparse. This review article aims to discuss critical factors for providers to consider in lesbian, gay, bisexual, transgender, queer, intersex, and asexual patients with hidradenitis suppurativa, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for sexual and gender minority patients.
Collapse
Affiliation(s)
- Jason Gomez
- Stanford School of Medicine, Stanford, California; Stanford Graduate School of Business, Stanford, California
| | - Leandra A Barnes
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - John Montgomery Yost
- Department of Dermatology, Stanford University School of Medicine, Stanford, California; Crossover Health, Menlo Park, California
| | - Justin Gordon
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | | | - Maria Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
11
|
Chen P, Simonetto DA, Paul S, Patel A. Health disparities experienced by sexual and gender minority individuals living with or at risk of chronic liver disease. Clin Liver Dis (Hoboken) 2023; 22:152-156. [PMID: 37908866 PMCID: PMC10615390 DOI: 10.1097/cld.0000000000000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/28/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Phillip Chen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Douglas A. Simonetto
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sonali Paul
- Department of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Arpan Patel
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Gastroenterology, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
12
|
Sullivan K, Simmang MK, Aguiar EJ, Winchester LJ, Wind SA, Esco MR, Fedewa MV. Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis. Prev Med 2023; 175:107708. [PMID: 37726039 DOI: 10.1016/j.ypmed.2023.107708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results. OBJECTIVE Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA. METHODS All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies. RESULTS The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (β = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (β = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables. CONCLUSIONS Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.
Collapse
Affiliation(s)
- Katherine Sullivan
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America; Division of Kinesiology, Health and Sport Studies, Wayne State University, Detroit, MI 48202, United States of America.
| | - Madelyn K Simmang
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Elroy J Aguiar
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Lee J Winchester
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Stefanie A Wind
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Michael R Esco
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| | - Michael V Fedewa
- Department of Kinesiology, The University of Alabama, Tuscaloosa, AL 35487, United States of America
| |
Collapse
|
13
|
Warwar S, Beach LB, Jordan SW. Breast cancer disparities among sexual and gender minority populations. Transl Cancer Res 2023; 12:2219-2223. [PMID: 37701114 PMCID: PMC10493785 DOI: 10.21037/tcr-23-623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Samantha Warwar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Sumanas W. Jordan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
14
|
Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
Collapse
Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
| |
Collapse
|
15
|
Stevens SD. Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates. Curr Obes Rep 2023:10.1007/s13679-023-00499-z. [PMID: 37140879 DOI: 10.1007/s13679-023-00499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations. RECENT FINDINGS Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.
Collapse
Affiliation(s)
- Serena D Stevens
- Cleveland Clinic Bariatric and Metabolic Institute, 9500 Euclid Ave./M61, Cleveland, OH, 44195, USA.
| |
Collapse
|
16
|
Birch JM, Jones RA, Mueller J, McDonald MD, Richards R, Kelly MP, Griffin SJ, Ahern AL. A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults. Obes Rev 2022; 23:e13438. [PMID: 35243743 PMCID: PMC9285567 DOI: 10.1111/obr.13438] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 12/26/2022]
Abstract
The extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster-) randomized controlled trials of primary care-applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS-Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty-six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered "more advantaged" did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.
Collapse
Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rebecca A Jones
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Matthew D McDonald
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | | | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
17
|
Prestemon CE, Grummon AH, Rummo PE, Taillie LS. Differences in Dietary Quality by Sexual Orientation and Sex in the United States: NHANES 2011-2016. J Acad Nutr Diet 2022; 122:918-931.e7. [PMID: 34896299 PMCID: PMC9038656 DOI: 10.1016/j.jand.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are persistent disparities in weight- and diet-related diseases by sexual orientation. Lesbian and bisexual females have a higher risk of obesity and cardiovascular disease compared with heterosexual females. Gay and bisexual males have a higher risk of diabetes and cardiovascular disease compared with heterosexual males. However, it remains unknown how sexual orientation groups differ in their dietary quality. OBJECTIVE This study aimed to determine whether dietary quality differs by sexual orientation and sex among US adults. DESIGN This was a cross-sectional study of 24-hour dietary recall data from a nationally representative sample of adults aged 20 through 65 years participating in the 2011-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING Study participants were adults (n = 8,851) with complete information on dietary intake, sexual orientation, and sex. MAIN OUTCOME MEASURES The main outcome measures were daily energy intake from 20 specific food and beverage groups and Healthy Eating Index-2015 (HEI-2015) scores for sexual orientation groups (heterosexual vs gay/lesbian/bisexual). STATISTICAL ANALYSES PERFORMED Ordinary least squares regressions were used to calculate adjusted means for each food and beverage group and HEI-2015, stratified by sex and controlling for covariates (eg, age and race/ethnicity) and survey cycles (2011-2012, 2013-2014, and 2015-2016). RESULTS Among males, red and processed meat/poultry/seafood (P = .01) and sandwiches (P = .02) were smaller contributors to energy intake for gay/bisexual males compared with heterosexual males. Among females, cereals (P =.04) and mixed dishes (P = .02) were smaller contributors to energy intake for lesbian/bisexual females compared with heterosexual females. Gay/bisexual males had significantly higher total HEI-2015 scores than heterosexual males (mean ± standard deviation 53.40 ± 1.36 vs 49.29 ± 0.32, difference = 4.14; P = .004). Lesbian/bisexual females did not differ in total or component HEI-2015 scores from heterosexual females. CONCLUSIONS Although gay/lesbian/bisexual groups were similar for a variety of dietary outcomes compared with heterosexual groups, gay and bisexual men displayed healthier dietary quality for processed meat (by consuming smaller amounts) and overall dietary quality (according to HEI-2015) compared with heterosexual males.
Collapse
Affiliation(s)
- Carmen E Prestemon
- Carolina Population Center, University of North Carolina, Chapel Hill, NC
| | - Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
| |
Collapse
|
18
|
Jackson TL, Chan PA, Scout NFN, Nocera LS, Crooks D, McCormick W, Bowman S, Lasher L, Sarvestani AS, Chambers LC. Statewide Evaluation of SARS-CoV-2 Diagnoses and Sexual Orientation and Gender Identity. Public Health Rep 2022; 137:580-587. [PMID: 35238242 PMCID: PMC9109525 DOI: 10.1177/00333549221077073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Understanding and identifying disparities in COVID-19 testing outcomes can help allocate resources to where they are most needed. The objective of this study was to estimate the association between lesbian, gay, bisexual, transgender, and queer (LGBTQ+) identity and SARS-CoV-2 test positivity. METHODS Data were from the Rhode Island SARS-CoV-2 surveillance database and included tests scheduled from June 8, 2020, through January 15, 2021. We used multivariable generalized estimating equations accounting for repeat testing to estimate the odds of receiving a positive test result for SARS-CoV-2 by LGBTQ+ identity and race/ethnicity, adjusting for sociodemographic and temporal confounders. RESULTS In multivariable analysis of 232 025 tests, LGBTQ+ people had lower odds of receiving a positive test result than cisgender heterosexual people (5.4% vs 8.7%; adjusted odds ratio [aOR] = 0.63; 95% CI, 0.59-0.68). Compared with cisgender heterosexual White people, LGBTQ+ White people were significantly less likely (aOR = 0.67; 95% CI, 0.61-0.73) and cisgender heterosexual people of color were significantly more likely (aOR = 1.71; 95% CI, 1.64-1.78) to receive a positive test result. LGBTQ+ people of color had similar test positivity (aOR = 0.90; 95% CI, 0.79-1.02) as cisgender heterosexual White people. People in sexual minority groups were significantly less likely than heterosexual people to receive a positive test result, but we found no significant differences in test results among cisgender, transgender, and gender nonconforming people. CONCLUSIONS LGBTQ+ people may be less likely than heterosexual people to receive a positive test result for SARS-CoV-2, potentially related to protective health practices and greater social isolation. Addressing racial and ethnic disparities among both LGBTQ+ people and cisgender heterosexual people should be a priority of the public health workforce.
Collapse
Affiliation(s)
- Tracy L. Jackson
- Rhode Island Department of Health,
Providence, RI, USA,Tracy L. Jackson, PhD, MPH, Rhode Island
Department of Health, 3 Capitol Hill, Providence, RI 02908, USA.
| | - Philip A. Chan
- Rhode Island Department of Health,
Providence, RI, USA,Brown University, Providence, RI,
USA
| | - NFN Scout
- Brown University, Providence, RI,
USA,National LGBT Cancer Network,
Providence, RI, USA
| | | | - Denise Crooks
- Psychiatry and Behavioral Health,
Lifespan Physician Group, East Providence, RI, USA
| | | | - Sarah Bowman
- Rhode Island Department of Health,
Providence, RI, USA
| | - Leanne Lasher
- Rhode Island Department of Health,
Providence, RI, USA
| | | | | |
Collapse
|
19
|
López Castillo H, Blackwell CW, Schrimshaw EW. Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis. Am J Mens Health 2022; 16:15579883221095387. [PMID: 35485875 PMCID: PMC9067055 DOI: 10.1177/15579883221095387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD −1.50 [−1.93, −1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox—a sustained catabolic state presenting with lower BMI—is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.
Collapse
Affiliation(s)
- Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA.,Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Christopher W Blackwell
- Department of Nursing Practice, College of Nursing, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | -
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
20
|
Adzrago D, Nyarko SH, Ananaba N, Asare M, Odame E, Jones A, Paul TK, Mamudu HM. Between and Within Sexual Identity-Group Differences in Asthma Prevalence in the United States. Respir Care 2022; 67:331-338. [PMID: 34599088 PMCID: PMC9993488 DOI: 10.4187/respcare.09258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although prior studies have established the association of asthma with smoking and obesity, literature on difference-in-differences analyses involving sexual identity is sparse. Therefore, this study aimed to examine the between and within sexual identity-group differences in asthma prevalence among individuals who smoke and are obese. METHODS We aggregated the 2017-2019 National Survey on Drug Use and Health data on adults (N = 128,319) to perform weighted multivariable logistic regression analysis and marginal estimates and marginsplot to determine asthma prevalence by sexual identity and the status of smoking and obesity. RESULTS About 66% of the study population reported having asthma. Among the individuals with asthma, 42% were obese, 10% were daily cigarette smokers, and 6% identified as bisexual persons. Lesbian/gay daily smokers (86%) or former smokers (75%) had a higher probability of having asthma than bisexual (daily smokers = 78% vs former smokers = 72%) and heterosexual (daily smokers = 68% vs former smokers = 65%) persons. Within each sexual identity subgroup, daily smokers (68-86%) had the highest probability of asthma. Obese bisexual (73%) or lesbian/gay (72%) persons had higher probabilities of having asthma than heterosexual persons (69%). Obese (73%) or overweight (72%) bisexual (compared to normal weight = 70% or underweight = 51%) and obese (69%) or overweight (65%) heterosexual (compared to normal weight = 62% or underweight = 57%) persons had the highest probabilities of having asthma within their groups, whereas overweight persons (overweight = 81% vs underweight = 79%, normal weight = 78%, and obese = 72%) had the highest probabilities within lesbian/gay persons. CONCLUSIONS Smoking and obesity show heightened odds for asthma, with significant odds for sexual minorities in asthma diagnosis relative to heterosexuals. These findings provide formative information for future longitudinal and experimental studies to explore these mechanisms of asthma risks among sexual and gender minorities.
Collapse
Affiliation(s)
- David Adzrago
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Samuel H Nyarko
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas
| | - Nnenna Ananaba
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Matt Asare
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Emmanuel Odame
- Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Antwan Jones
- Department of Sociology and Department of Epidemiology, The George Washington University, Washington, District of Columbia
| | - Timir K Paul
- University of Tennessee at Nashville, Nashville, Tennessee
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| |
Collapse
|
21
|
The association between sexual orientation, BMI, obesity diagnosis, and provider recommendation for weight management. BMC Womens Health 2022; 22:19. [PMID: 35081936 PMCID: PMC8793187 DOI: 10.1186/s12905-021-01585-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background National data show that lesbian and bisexual women are more likely to be obese compared to straight women. However little is known about whether provider recommendation for weight management varies across these populations. Furthermore, health care providers have explicit and implicit preferences for straight people in comparison to lesbian or gay people. There is little research that exists depicting how this preference affects quality of patient care. The purpose of the study is: to compare, among lesbian, bisexual, and straight females with BMIs ≥ 30: (1) the average Body Mass Index (BMI); (2) receipt of a diagnostic code for obesity; and (3) receipt of a provider recommendation for weight management. Methods We performed a cross-sectional study of 534 patient records from four outpatient academic internal medicine practices at the University of Pennsylvania between January 1, 2019 to December 31, 2019 to determine variations in average BMI, proportion of International Classification of Diseases (ICD)-10 codes for obesity, and proportion of weight management recommendations offered by providers among lesbian, bisexual and straight females with BMIs ≥ 30. We classified provider recommendations as definite, possible, and absent. Multivariable median (BMI outcome only) or logistic regression was used to evaluate the associations between sexual orientation and each of the following outcomes: BMI, receipt of obesity diagnosis, and weight management recommendations. Results There were no significant differences in BMI, receipt of obesity diagnoses, or weight management recommendations between lesbian, bisexual, and straight females with BMIs ≥ 30. However, only about half the patients with BMIs ≥ 30, regardless of sexual orientation, received a weight management recommendation as recommended by the United States Preventive Services Task Force (USPSTF) guidelines. Conclusion We did not observe disparities in BMI, receipt of obesity diagnoses, or receipt of weight management recommendations between sexual orientation minority and heterosexual females among this sample from an urban population of patients receiving care in a university medical system. However, provider recommendation for weight management was suboptimal in all the groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01585-x.
Collapse
|
22
|
Ancheta AJ, Caceres BA, Zollweg SS, Heron KE, Veldhuis CB, VanKim NA, Hughes TL. Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women. Eat Behav 2021; 43:101547. [PMID: 34412003 PMCID: PMC8629849 DOI: 10.1016/j.eatbeh.2021.101547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023]
Abstract
Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.
Collapse
Affiliation(s)
- April J Ancheta
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Sarah S Zollweg
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, 250 Mills Godwin Building, Norfolk, VA 23529, United States of America.
| | - Cindy B Veldhuis
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences University of Massachusetts Amherst, 406 Arnold House, Amherst, MA 01003, United States of America.
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| |
Collapse
|
23
|
Lynch KE, Shipherd JC, Gatsby E, Viernes B, DuVall SL, Blosnich JR. Sexual orientation-related disparities in health conditions that elevate COVID-19 severity. Ann Epidemiol 2021; 66:5-12. [PMID: 34785397 PMCID: PMC8601164 DOI: 10.1016/j.annepidem.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Abstract
Purpose The Veterans Health Administration (VA) is the largest single integrated healthcare system in the US and is likely the largest healthcare provider for people with minoritized sexual orientations (e.g., gay, lesbian, bisexual). The purpose of this study was to use electronic health record (EHR) data to replicate self-reported survey findings from the general US population and assess whether sexual orientation is associated with diagnosed physical health conditions that may elevate risk of COVID-19 severity among veterans who utilize the VA. Methods A retrospective analysis of VA EHR data from January 10, 1999–January 07, 2019 analyzed in 2021. Veterans with minoritized sexual orientations were included if they had documentation of a minoritized sexual orientation within clinical notes identified via natural language processing. Veterans without minoritized sexual orientation documentation comprised the comparison group. Adjusted prevalence and prevalence ratios (aPR) were calculated overall and by race/ethnicity while accounting for differences in distributions of sex assigned at birth, age, calendar year of first VA visit, volumes of healthcare utilization, and VA priority group. Results Data from 108,401 veterans with minoritized sexual orientation and 6,511,698 controls were analyzed. After adjustment, veterans with minoritized sexual orientations had a statistically significant elevated prevalence of 10 of the 11 conditions. Amongst the highest disparities observed were COPD (aPR:1.24 [95% confidence interval:1.23–1.26]), asthma (1.22 [1.20–1.24]), and stroke (1.26 [1.24–1.28]). Conclusions Findings largely corroborated patterns among the general US population. Further research is needed to determine if these disparities translate to poorer COVID-19 outcomes for individuals with minoritized sexual orientation.
Collapse
Affiliation(s)
- Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA.
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA; National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Elise Gatsby
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Benjamin Viernes
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
24
|
Escobar-Viera CG, Melcher EM, Miller RS, Whitfield DL, Jacobson-López D, Gordon JD, Ballard AJ, Rollman BL, Pagoto S. A systematic review of the engagement with social media-delivered interventions for improving health outcomes among sexual and gender minorities. Internet Interv 2021; 25:100428. [PMID: 34401387 PMCID: PMC8350614 DOI: 10.1016/j.invent.2021.100428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sexual and gender minority (SGM) persons face a number of physical and mental health disparities closely linked to discrimination, social stigma, and victimization. Despite the acceptability and increasing number of digital health interventions focused on improving health outcomes among SGM people, there is a lack of reviews summarizing whether and how researchers assess engagement with social media-delivered health interventions for this group. OBJECTIVE The objective of this systematic review was to synthesize and critique the evidence on evaluation of engagement with social media-delivered interventions for improving health outcomes among SGM persons. METHODS We conducted a literature search for studies published between January 2003 and June 2020 using 4 electronic databases. Articles were included if they were peer-reviewed, in English language, assessed engagement with a social media-delivered health intervention for improving health outcomes among sexual and gender minorities. A minimum of two authors independently extracted data from each study using an a priori developed abstraction form. We assessed quality of data reporting using the CONSORT extension for pilot and feasibility studies and CONSORT statement parallel group randomized trials. RESULTS We included 18 articles in the review; 15 were feasibility studies and 3 were efficacy or effectiveness randomized trials. The quality of data reporting varied considerably. The vast majority of articles focused on improving HIV-related outcomes among men who have sex with men. Only three studies recruited cisgender women and/or transgender persons. We found heterogeneity in how engagement was defined and assessed. Intervention usage from social media data was the most frequently used engagement measure. CONCLUSION In addition to the heterogeneity in defining and assessing engagement, we found that the focus of assessment was often on measures of intervention usage only. More purposeful recruitment is needed to learn about whether, how, and why different SGM groups engage with social media-interventions. This leaves significant room for future research to expand evaluation criteria for cognitive and emotional aspects of intervention engagement in order to develop effective and tailored social media-delivered interventions for SGM people. Our findings also support the need for developing and testing social media-delivered interventions that focus on improving mental health and outcomes related to chronic health conditions among SGM persons.
Collapse
Affiliation(s)
- César G. Escobar-Viera
- Department of Psychiatry, School of Medicine, University of Pittsburgh, United States of America
| | - Eleanna M. Melcher
- School of Medicine and Public Health, University of Wisconsin-Madison, United States of America
| | - Rebekah S. Miller
- Health Sciences Library System, University of Pittsburgh, United States of America
| | | | - Daniel Jacobson-López
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, United States of America
| | - Jacob D. Gordon
- School of Social Work, University of Pittsburgh, United States of America
| | - Adrian J. Ballard
- School of Social Work, University of Pittsburgh, United States of America
| | - Bruce L. Rollman
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, School of Medicine, University of Pittsburgh, United States of America
| | - Sherry Pagoto
- UConn Center for mHealth and Social Media, Department of Allied Health Sciences, College of Agriculture, Health, and Natural Sciences, University of Connecticut, United States of America
| |
Collapse
|
25
|
Cordie A, AbdAllah M, Vergori A, Kharono B, Karkouri M, Esmat G. Human immunodeficiency virus (HIV) and coronavirus disease 2019; impact on vulnerable populations and harnessing lessons learnt from HIV programmes. New Microbes New Infect 2021; 41:100857. [PMID: 33680476 PMCID: PMC7912358 DOI: 10.1016/j.nmni.2021.100857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 02/01/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) can act as a dual prong attack against management of people living with human immunodeficiency virus (HIV); it induces harm on both individual and national levels. People living with HIV may show rapid deterioration in severe acute respiratory syndrome coronavirus 2 infection as a result of physiological or psychological vulnerability. Additionally, the spread of COVID-19-especially in low- and middle-income countries-may limit HIV control measures, delivery and linkage to HIV care and prevention. Attention should be given to pregnant women and the LGBTQI+ community for their higher susceptibility to poor outcomes. Engagement of both governmental and non-governmental organizations is encouraged for better results.
Collapse
Affiliation(s)
- A. Cordie
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M. AbdAllah
- Medical Research Division, National Research Centre, Giza, Egypt
| | - A. Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases L.Spallanzani, IRCCS, Rome, Italy
| | - B. Kharono
- University of Washington, Seattle, WA, USA
| | - M. Karkouri
- Association de Lutte Contre le Sida/Coalition Plus, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - G. Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
26
|
Lund EM, Burgess CM. Sexual and Gender Minority Health Care Disparities: Barriers to Care and Strategies to Bridge the Gap. Prim Care 2021; 48:179-189. [PMID: 33985698 DOI: 10.1016/j.pop.2021.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gender and sexual minority individuals face considerable physical and mental health disparities, health risk factors, and barriers to care. These disparities are rooted in systemic and interpersonal prejudice, discrimination, and violence toward lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) individuals and communities that place LGBTQ+ individuals at increased risk for negative social determinants of health. While also advocating for systemic change, individual providers and clinics have an ethical duty to promote an openly affirming, culturally competent health care environment that can help to address these disparities on an individual patient level.
Collapse
Affiliation(s)
- Emily M Lund
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, PO Box 870231, Tuscaloosa, AL 35487, USA.
| | - Claire M Burgess
- VA Boston Healthcare System, Harvard Medical School, 940 Belmont Street, Brockton, MA 02310, USA
| |
Collapse
|
27
|
Jacob L, López-Sánchez GF, Haro JM, Koyanagi A, Kostev K, Grabovac I, Oh H, Pardhan S, McDermott D, Shin JI, Smith L. Association between sexual orientation and subjective cognitive complaints in the general population in England. J Psychiatr Res 2021; 136:1-6. [PMID: 33540178 DOI: 10.1016/j.jpsychires.2021.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
There is a scarcity of literature investigating the association between minority sexual orientations and subjective cognitive complaints (SCC). Therefore, the aim of this study was to investigate the association between identifying as a sexual minority and SCC in a large sample of adults from England. The study further aimed to identify the extent to which the association could be explained by several behavioral, psychological and clinical factors. Cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. Sexual orientation was dichotomized into heterosexual and sexual minority orientation. SCC referred to subjective concentration and memory complaints. Control variables included sex, age, ethnicity, marital status, education, employment, and income. Influential factors included smoking status, alcohol dependence, perceived stress, the number of stressful life events, depression, any anxiety disorder, sleep problems, and obesity. This study included 7,400 participants (51.4% women; mean [standard deviation] age 46.3 [18.6] years). After adjusting for control variables, sexual minority orientation was positively and significantly associated with subjective concentration (OR = 1.40, 95% CI = 1.12-1.76) but not memory complaints (OR = 1.19, 95% CI = 0.96-1.47). The number of stressful life events, sleep problems and any anxiety disorder explained 13.4%, 11.0% and 10.9% of the association between sexual orientation and subjective concentration complaints, respectively. In this large sample of English adults, identifying as a sexual minority was significantly associated with subjective concentration complaints, while stressful life events, sleep problems, and anxiety explained a large proportion of the association. Targeted interventions towards sexual minority groups to reduce SCC may be warranted.
Collapse
Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, 78180, France
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, United Kingdom.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Karel Kostev
- Philipps University of Marburg, Marburg, Germany
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, 1149 South Hill Street suite 1422, Los Angeles, CA, 90015, USA
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, United Kingdom
| | - Daragh McDermott
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
28
|
Pereira H. Sexual Health Determinants of Normal Weight, Overweight, and Obese Sexual Minority Men. J Obes 2021; 2021:1272316. [PMID: 33815839 PMCID: PMC7994078 DOI: 10.1155/2021/1272316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With the growing recognition of overweight and obesity as significant, international public health concerns, the body of research investigating the relationship between body mass index (BMI), sexual health, and sexual functioning in sexual minority men is still scarce. OBJECTIVE The purpose of this study is to assess sexual health determinants (sexual behavior and sexual functioning) in relation to normal weight, overweight, and obesity among gay and bisexual men. METHODS AND MATERIALS The survey included four categories of questions/measurements, encompassing sociodemographic information, protected/unprotected sexual behaviors, sexual functioning, and BMI. The survey was conducted online, and recruitment consisted of online notifications (emails and electronic messages) and advertisements sent to LGBT community organizations, mailing lists, and social networks. RESULTS The study sample was composed of 741 gay and bisexual men, ranging in age from 21 to 75 years (M age = 43.30, SDage = 11.37); 62.5% of men self-identified as gay and 37.5% as bisexual. Prevalence of normal weight was 50.3%, of overweight, 33.3%, and of obesity, 16.4%. Participants with overweight and obesity showed a lower frequency of anal receptive sex without condoms when scompared to participants with normal weight. Hierarchical multiple regression analysis to assess the effects of BMI on sexual health showed that being younger in age, self-identifying as gay, being in a relationship, having longer penises, adopting insertive position in sex, and being normal weight were significant predictors of anal receptive sex without condoms, explaining 24.2% of the total variance. Yet, BMI was not predictive of sexual functioning. CONCLUSION These findings highlight the importance of including BMI in sexual behavior models of sexual minority men to better understand BMI's role in influencing sexual risk.
Collapse
Affiliation(s)
- Henrique Pereira
- Department of Psychology and Education, University of Beira Interior, Covilhã 6200-209, Portugal
- The Health Sciences Research Centre (CICS-UBI), Covilhã, Portugal
- The Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
| |
Collapse
|
29
|
Panza E, Olson K, Selby EA, Wing RR. State versus trait weight, shape, and eating concerns: Disentangling influence on eating behaviors among sexual minority women. Body Image 2021; 36:107-116. [PMID: 33279785 PMCID: PMC7987775 DOI: 10.1016/j.bodyim.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/20/2023]
Abstract
This study examined the relative influence of trait and state weight, shape, and eating concerns on dysregulated eating in the daily lives of sexual minority women with overweight and obesity. This study is a secondary analysis of data from an Ecological Momentary Assessment (EMA) study of 55 sexual minority women with overweight/obesity. Trait shape, weight, and eating concerns were assessed at baseline. For the following five days, participants used a smartphone to report state weight/shape concerns, overeating, and binge eating five times daily. Women who endorsed higher levels of trait weight, shape, and eating concerns at baseline reported more frequent state weight/shape concerns in daily life. Trait eating concerns were associated with higher odds of binge eating during EMA, but trait weight/shape concerns were unrelated to future dysregulated eating. In daily life, state weight/shape concerns was associated with greater risk for over/binge eating at the concurrent EMA prompt, the subsequent EMA prompt, and over the course of a full day, independent of trait concerns. State weight and shape concerns may play an important role in predicting dysregulated eating in daily life among sexual minority women of higher body weight.
Collapse
Affiliation(s)
- Emily Panza
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - KayLoni Olson
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate and emphasize important findings in the recent literature regarding the socioeconomics of obesity. It is important to evaluate trends of this global epidemic and elucidate its impact on different demographic groups and across socioeconomic strata. RECENT FINDINGS Obesity rates continue to increase domestically and globally which is associated with a concomitant rise in medical and economic costs. There are disparities in obesity rates based on race/ethnicity, sex, gender and sexual identity, and socioeconomic status, yet these disparities are not explained fully by health behaviors, socioeconomic position, or cumulative stress alone-community and societal environmental factors have a significant role in the obesity epidemic. Socioeconomic factors contribute to obesity on an individual and community level, and any viable approach to sustainably addressing the obesity epidemic must take these factors into account.
Collapse
Affiliation(s)
- Chika Vera Anekwe
- MGH Weight Center, Department of Medicine- Division of Endocrinology-Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Amber R Jarrell
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | | | | | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA
- MGH Weight Center, Department of Medicine- Division of Endocrinology-Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics-Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
31
|
Soulliard ZA, Cox S, Brode C, Platt L, Tabone LE, Szoka N. Sexual minority bariatric patients: preliminary examination of eating behaviors, anxiety, and depression. Surg Obes Relat Dis 2020; 16:1692-1700. [PMID: 32828688 DOI: 10.1016/j.soard.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/19/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disparities in obesity care and bariatric surgery persist among patients of diverse identities. However, little is known about sexual minority (SM) bariatric patients. OBJECTIVES This study sought to describe, in a preliminary fashion, sexual orientation variables of outness, self-esteem, and perceived discrimination among a sample of SM patients pursuing bariatric surgery. The study also sought to compare SM and heterosexual bariatric candidates on measures of eating behaviors, anxiety, and depression. SETTING Academic medical center in the United States. METHODS Data were collected as part of a standard psychological evaluation for surgical clearance between May 1, 2018 and December 31, 2019. Data included demographic characteristics, sexual orientation variables, eating behaviors, anxiety, and depression. Descriptive statistics were included to present findings among SM patients. One-way analyses of covariance were conducted to assess differences between SM and heterosexual patients. RESULTS A total of 633 patients were evaluated (38 SM and 595 heterosexual). SM patients had high outness scores with high self-esteem and minimal perceived discrimination. SM patients endorsed lower cognitive restraint, higher disinhibition, and increased hunger compared with heterosexual patients (P < .05). SM patients also reported significantly more symptoms of anxiety and depression compared with heterosexual patients (P < .05). CONCLUSIONS Findings provide preliminary evidence toward the importance of assessing for sexual orientation among bariatric patients. Future research is warranted to assess the unique role of sexual orientation, as well as explore causal links between sexual orientation, eating behaviors, and mental health among bariatric patients pre- and post surgery.
Collapse
Affiliation(s)
- Zachary A Soulliard
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Cassie Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lisa Platt
- Department of Counseling Psychology, West Virginia University, Morgantown, West Virginia
| | - Lawrence E Tabone
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
32
|
Warner JJ, Benjamin IJ, Churchwell K, Firestone G, Gardner TJ, Johnson JC, Ng-Osorio J, Rodriguez CJ, Todman L, Yaffe K, Yancy CW, Harrington RA. Advancing Healthcare Reform: The American Heart Association's 2020 Statement of Principles for Adequate, Accessible, and Affordable Health Care: A Presidential Advisory From the American Heart Association. Circulation 2020; 141:e601-e614. [PMID: 32008369 DOI: 10.1161/cir.0000000000000759] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mission of the American Heart Association is to be a relentless force for a world of longer, healthier lives. The American Heart Association has consistently prioritized the needs and perspective of the patient in taking positions on healthcare reform while recognizing the importance of biomedical research, providers, and healthcare delivery systems in advancing the care of patients and the prevention of disease. The American Heart Association's vision for healthcare reform describes the foundational changes needed for the health system to serve the best interests of patients and to achieve health care and coverage that are adequate, accessible, and affordable for everyone living in the United States. The American Heart Association is committed to advancing the dialogue around healthcare reform and has prepared this updated statement of our principles, placed in the context of the advances in coverage and care that have occurred after the passage of the Affordable Care Act, the rapidly changing landscape of healthcare delivery systems, and our evolving recognition that efforts to prevent cardiovascular disease can have synergistic benefit in preventing other diseases and improving overall well-being. These updated principles focus on expanding access to affordable health care and coverage; enhancing the availability of evidence-based preventive services; eliminating disparities that limit the availability and equitable delivery of health care; strengthening the public health infrastructure to respond to social determinants of health; prioritizing and accelerating investments in biomedical research; and growing a diverse, culturally competent health and healthcare workforce prepared to meet the challenges of delivering high-value health care.
Collapse
|